Increasing Incidence of Extended-Spectrum β-Lactamase-Producing<i>Escherichia coli</i>in Community Hospitals throughout the Southeastern United States

Thaden, Joshua T.; Fowler, Vance G.; Sexton, Daniel J.; Anderson, Deverick J.

doi:10.1017/ice.2015.239

Cited by 118 publications

(96 citation statements)

References 26 publications

(31 reference statements)

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“…The evidence shows that the prevalence of ESBL‐P Enterobacteriaceae is increasing at both hospital and community settings globally. A thorough knowledge in terms of the prevalence of ESBL‐P Enterobacteriaceae in maternal UTIs in various geographic regions is clinically important from two aspects.…”

Section: Introductionmentioning

confidence: 99%

Extended‐spectrum beta‐lactamase (ESBL)‐producingEnterobacteriaceaeand urinary tract infections in pregnant/postpartum women: A systematic review and meta‐analysis

et al. 2019

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Background Urinary tract infections (UTI) and asymptomatic bacteriuria (AB) during pregnancy can result in considerable maternal and foetal adverse outcomes. Production of extended‐spectrum beta‐lactamase (ESBL) is a major antibiotic resistance mechanism by Enterobacteriaceae. Objectives To determine the global prevalence of ESBL‐producing (ESBL‐P) Enterobacteriaceae in symptomatic UTI/AB among pregnant/postpartum females. Data sources A systematic review of the PubMed, Embase, Scopus, WOS (Web of Science), ProQuest and the grey literature was conducted. Study selection and data extraction Studies that reported the frequency of ESBL‐P Enterobacteriaceae in pregnant/postpartum women with UTI and/or AB were eligible. First, the titles and abstracts of the retrieved articles were reviewed. Then, the full texts of the remained articles were reviewed. Synthesis In order to estimate the pooled prevalence and the 95% confidence interval (95% CI), meta‐analysis was performed using the random‐effects model. Results Twenty‐three studies (six from Africa, two from North America, one from South America, 12 from Asia and two European studies) that reported data on 20 033 Enterobacteriaceae strains were included. The pooled prevalence of ESBL‐P Enterobacteriaceae was 25% (95% CI 18%, 32%); I2 = 98.8%. The estimated prevalence (95% CI) rates were 45% (22, 67%) in Africa, 33% (22, 44%) in India, 15% (6, 24%) in other Asian countries, 5% (2, 8%) in Europe, 4% (1, 11%) in South America and 3% (1, 5%) in North America (P < .001). This estimate was 21% (95% CI 11, 31%) in patients with symptomatic UTI and it was 28% (95% CI 15, 41%) in patients with AB (P = .40). Conclusions The prevalence of ESBL‐P Enterobacteriaceae among pregnant women with UTI/AB was significant and geographic region was a major source for heterogeneity. The findings could be taken into account by healthcare providers and programmers in the management and antibiotic selection of UTI/AB during pregnancy, especially in high prevalence areas.

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Section: Introductionmentioning

confidence: 99%

Extended‐spectrum beta‐lactamase (ESBL)‐producingEnterobacteriaceaeand urinary tract infections in pregnant/postpartum women: A systematic review and meta‐analysis

et al. 2019

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“…These types of resistant bacteria are increasingly implicated as causes of both community- and hospital-acquired infections [6, 7] and are associated with higher levels of mortality than non-ESBL producers [8]. Across sub-Saharan Africa, a limited number of studies have described high levels of ESBL faecal carriage in children in association with hospital facilities [9–13].…”

Section: Introductionmentioning

confidence: 99%

Carriage of antibiotic-resistant Enterobacteriaceae in hospitalised children in tertiary hospitals in Harare, Zimbabwe

Magwenzi

Gudza-Mugabe

Mujuru

et al. 2017

Antimicrob Resist Infect Control

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BackgroundExtended-spectrum β-lactamase-producing and gentamicin resistant Enterobacteriaceae are increasingly recognised as a major cause of infection in low-income countries. We assessed the prevalence of gastrointestinal carriage of these bacteria in hospitalised children in Harare, Zimbabwe.MethodsWe conducted a cohort study in paediatric inpatients at two tertiary-referral hospitals between May and July 2015. Rectal swabs and faecal samples were collected within 24 h of admission and further follow-up samples were collected on alternate days during hospitalization. Disc-based, selective and enrichment methods were used to detect carriage of these two forms of resistance. Standard methods were used to confirm resistance status and determine the susceptibility of resistant isolates to other commonly-used antibiotics.ResultsOne hundred and sixty four paediatric inpatient admissions (median age = 1.0 year, IQR = 0.2–2.2years) were enrolled, and an average of 1.9 faecal samples per patient were collected. On admission, 68/164 (41%) patients had both ESBL and gentamicin-resistant Enterobacteriaceae detected, 18 (11%) had ESBL only, 17 (10%) had gentamicin resistance only and 61 (37%) had negative screening for both forms of resistance. During hospitalisation, 32/164 (20%) patients were found to have a type of resistant organism which was not present in their admission sample. We found that faecal samples and use of a selective enrichment broth enhanced the detection of resistant organisms. Amongst resistant bacteria isolated, there were high levels of resistance to ciprofloxacin and chloramphenicol, but not ertapenem.ConclusionsMore than half of children had enteric carriage of a clinically-relevant form of antibiotic resistance on admission to public-sector hospitals in urban Zimbabwe. Additionally, a fifth of children acquired a further form of resistance during hospitalisation. Urgent action is needed to tackle the spread of antibiotic resistant enteric bacteria in African hospitals.

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“…This observation may be due to differences in host factors, as patients with ESC-R K. pneumoniae are more likely than those with ESC-R E. coli to have hospital-acquired infections or previous health care exposure and/or chronic medical conditions (18,19). Finally, we observed an especially high rate of concordance (71%) among patients with index infections with the ST131-associated E. coli type 40-30 strain.…”

Section: Discussionmentioning

confidence: 68%

Antibiotic Prophylaxis Is Associated with Subsequent Resistant Infections in Children with an Initial Extended-Spectrum-Cephalosporin-Resistant Enterobacteriaceae Infection

Das

Adler²,

Miles-Jay

et al. 2017

Antimicrob Agents Chemother

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The objective of this study was to assess the association between previous antibiotic use, particularly long-term prophylaxis, and the occurrence of subsequent resistant infections in children with index infections due to extended-spectrumcephalosporin-resistant Enterobacteriaceae. We also investigated the concordance of the index and subsequent isolates. Extended-spectrum-cephalosporin-resistant Escherichia coli and Klebsiella spp. isolated from normally sterile sites of patients aged Ͻ22 years were collected along with associated clinical data from four freestanding pediatric centers. Subsequent isolates were categorized as concordant if the species, resistance determinants, and fumC-fimH (E. coli) or tonB (Klebsiella pneumoniae) type were identical to those of the index isolate. In total, 323 patients had 396 resistant isolates; 45 (14%) patients had Ն1 subsequent resistant infection, totaling 73 subsequent resistant isolates. The median time between the index and first subsequent infections was 123 (interquartile range, 43 to 225) days. In multivariable Cox proportional hazards analyses, patients were 2.07 times as likely to have a subsequent resistant infection (95% confidence interval, 1.11 to 3.87) if they received prophylaxis in the 30 days prior to the index infection. In 26 (58%) patients, all subsequent isolates were concordant with their index isolate, and 7 (16%) additional patients had at least 1 concordant subsequent isolate. In 12 of 17 (71%) patients with E. coli sequence type 131 (ST131)-associated type 40-30, all subsequent isolates were concordant. Subsequent extended-spectrum-cephalosporin-resistant infections are relatively frequent and are most commonly due to bacterial strains concordant with the index isolate. Further study is needed to assess the role prophylaxis plays in these resistant infections.

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Increasing Incidence of Extended-Spectrum β-Lactamase-ProducingEscherichia coliin Community Hospitals throughout the Southeastern United States

Cited by 118 publications

References 26 publications

Extended‐spectrum beta‐lactamase (ESBL)‐producingEnterobacteriaceaeand urinary tract infections in pregnant/postpartum women: A systematic review and meta‐analysis

Extended‐spectrum beta‐lactamase (ESBL)‐producingEnterobacteriaceaeand urinary tract infections in pregnant/postpartum women: A systematic review and meta‐analysis

Carriage of antibiotic-resistant Enterobacteriaceae in hospitalised children in tertiary hospitals in Harare, Zimbabwe

Antibiotic Prophylaxis Is Associated with Subsequent Resistant Infections in Children with an Initial Extended-Spectrum-Cephalosporin-Resistant Enterobacteriaceae Infection

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